May 16, 2014

The obvious question to ask about the VA scandal is: Why? Why would a VA hospital administrator direct doctors not to perform colonoscopies until patients had three positive tests for bloody stools? Or why were VA employees ordered to “cook the books” and hide long wait times that veterans faced when seeking care from heart, cancer, or other specialists? Why did some VA administrators go so far as to create a secret waiting list to hide year-plus wait times?

There’s only one plausible answer to these questions: rationing. The VA is but a smaller version of the sort of government-run, single-payer health care with which the political left is so enamored.

When individuals receive care through the VA, it becomes the only payer and hence, the only decision-maker. The VA decides who gets care, when, and how much. Moreover, as the single payer, the VA bears the risk of loss: If tax dollars aren’t enough to pay for the care demanded, there’s only one result — rationing of care.

Rationing care can take many forms. It can be overt, like the Canadian or British health care systems, which have unambiguous, publicly-announced waiting times and coverage denials for certain procedures. Or rationing can be more subtle, with little or no public participation. This latter, covert form of rationing is what the VA has adopted.

I know a dentist who "works" at the VA. Listing the litany of nonsense he's put up with to actually WORK is impossible. The waste he described, the utter lack of concern about productivity, the ludicrous mismanagement of something as relatively simply as a dental clinic and the pay and benefits given employees would have been shocking but for the fact that it is the government "running" the clinic. Obscene doesn't even begin to describe the mismanagement of that clinic.

Not only the rationing problem is exposed here - the information problem also is.

One virtue of the market is that it indirectly communicates information to decision makers that might otherwise be invisible or hidden.

The management of a private firm staffed by employees that were screwing customers like this has a ready means to know that it's happening - their customers abandon them and go to other firms. That gives management a way to know if their employees are screwing up that doesn't rely on the honesty of the employees.

Statists believe they can replace the discipline of the market with "metrics". "Well, since market discipline is mean and unfair, we'll replace that by having our staff fill out a form when someone doesn't get service within a particular period of time." Great plan. Except your employees will lie. Because if telling the truth means they will face a negative consequence, a great many people won't tell the truth.

In addition to all the other Hayekian information problems planners face, the problem of self-interested deception across the chain of command is one that's pretty difficult to overcome.

Another factor is that at the VA doctors don't work for the patients, they work for the government. Complacency among government workers is well known. Employing an EPA worker who watches porn for six hours a day is a waste of taxpayer money-when medicine is involved a worker who knows he or she won't be fired presents a whole different level of urgency. Soon, all doctors will be government employees. Chew on that for a while.

As a vet in the V.A. system i can confirm the rationing. i've used several facilities. Average wait for primary care is two months. The effect of two wars has been the doubling at least of the number of patients with no increase of caregivers. At least some of this could be remedied by congress with carefully applied appropriations.

I checked the Veteran's Health Administration page on Wikipedia and it has a list of positive comparisons versus, e.g., Medicare by Rand and others. What does that say about the rest of the US health care system, and why can't we do anything right these days?

You could do the same by pointing to the Indian Health Service. Or at County County (Stroger) Hospital.

But most of the advocates for single payer don't plan to use the system they foist on us. The apparatchiks and the nomenklatura will have a separate system for themselves. They always do -- check out the old Soviet Union and present-day Cuba for examples.

Good grief, people, the VA has ALWAYS rationed care in one way or another. One common way was to limit care (in total or in certain disciplines) to "service-connected" vets -- those with an illness or disability directly related to their military service. If you weren't service connected you were at the end of the line; if you were service connected you were 2nd to the end of the line.

VA hospitals and clinics over the last several decades limited care overtly through budget restrictions, hiring caps for doctors and nurses, and space limitations. You can't provide care if you don't have funding, staff and space. They limited care covertly through a maze of rules. Try complying.

I worked at three VA hospitals (two as a medical student, one as a resident) and learned how they worked. They've ALWAYS limited care. They always WILL. They'll never be given enough funding, facilities and staff to provide all the care that veterans, service-connected or not, will want and need. Never.

And just about everyone who works at a VA; doctor, nurse, tech, ward clerk, wherever, knows it. We all knew it. That's just the way it was.

The real crime of the Obama administration VA? They were clumsy and got caught.

As long as health care resources are finite (any they always will be), medical care will always be rationed. Rationing is by access or cost. And when any kind of single payer system is in place medical care will be rationed every way possible. I have personal experience with this in both my former military career and my present ministerial vocation. I wrote about it five years ago in, "I want health care free."http://senseofevents.blogspot.com/2009/09/i-want-health-care-free.html

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